The meeting started at 6:07pm Attendance Connecticut Medicaid P&T Meeting Minutes November 19, 2014 Present Members: Carl Sherter, MD Manage Nissanka, MD Emmett Sullivan, RPh Stella Cretella Kevin Chamberlin, PharmD Hilda Slivka, MD Elizabeth Rodríguez, RN Andrew Lustbader, MD Jeffrey Messina, RPh. Absent Members: Karen McMillan, RN Charles Thompson, MD Jeffrey Kamradt, MD DSS: Jason Gott, RPh HP/Magellan: Jason Young, PharmD Heather Kissinger, PharmD (HID) Margaret Stroczkowski Kathy Novak, RPh (Magellan) Opening remarks: Carl Sherter thanked the attendees for coming and called meeting to order at 6:07 pm. Jeffrey Messina was introduced as a new member to the Connecticut P&T committee. Jason Gott informed the committee that the Acne Agents and Cytokine and CAM Antagonists were the next two classes that would be subject to the step therapy PA process. The committee did not have any objections to these classes. The implementation date is still TBD. Jason G announced that the Web PA Portal has been created, and providers can now submit pharmacy prior authorizations through the secure web portal. He noted that prior authorizations can still be faxed. Carl S questioned whether providers were notified and Jason Young responded that HP had sent a bulletin and a welcome letter to individual providers with log-on information for this feature. Jason G informed that committee that HP/DSS are in the process of developing a procedure for requiring prior authorization on the Hepatitis C drug Sovaldi, due to high costs associated with this drug. He stated criteria would be drawn from FDA approved indications on package label.
The revised P&T Committee Bylaws were unanimously approved by the committee members present, and will go into effect immediately. The minutes from the previous meeting, held April 30, 2014, were unanimously approved by the committee members present. Public Presentations: 1. Antidepressants, Other a. Antidepressant Class Testimony Dale Wallington, MD b. Class Testimony Paul Desan, MD CT Psychiatric Society c. Viibryd, Fetzima Bassam Awwa, MD d. Brintellix Christopher Carello, PhD Takeda e. Pristiq Aniello Marotta, PharmD Pfizer 2. Anticonvulsants a. Aptiom John McCarty, Sunovion 3. Bronchodilators, Beta Agonist a. Ventolin HFA Adam Denman, GSK 4. COPD Agents a. Anoro Ellipta Adam Denman, GSK b. Daliresp, Tudorza Patrick Troy, MD 5. Cytokine and CAM Antagonists a. Xeljanz Aniello Marotta, PharmD Pfizer b. Simponi, Stelara Arlene Price, PharmD Janssen 6. Epinephrine, Self-injected a. Epipen and Epipen Jr. Margaret Marsh, PharmD Mylan 7. Glucocorticoids, Inhaled a. Breo Ellipta Adam Denman, GSK 8. Intranasal Rhinitis Agents a. QNASL Alissa Amara, Teva 9. Oncology Agents, Oral a. Connecticut Oncology Assoc. Dawn Holcombe The rest of the scheduled speakers waived their right to speak because either their product was recommended as preferred on the PDL, or they were not in attendance. Therapeutic Class Reviews: Antipsychotics
Prior to revealing recommendations or public testimonies, Carl S conducted an unofficial straw poll to see if any of the committee members wished to change their previous position of having all agents in this class listed as preferred on the PDL. The committee was unanimously in favor. All speakers waived their rights to present. Andrew Lustbader motioned for all products in this class to have preferred status, was seconded by Hilda Slivka, and the motion passes unanimously. ON Medicaid PDL: ABILIFY (INTRAMUSC), ABILIFY DISCMELT (ORAL), ABILIFY MAINTENA (INTRAMUSC.), ABILIFY SOLUTION (ORAL), ABILIFY TABLET (ORAL), ADASUVE (INHALATION), AMITRIPTYLINE / PERPHENAZINE (ORAL), CHLORPROMAZINE (ORAL), CLOZAPINE (ORAL), CLOZAPINE ODT (ORAL), CLOZARIL (ORAL), FANAPT TABLET (ORAL), FANAPT TITRATION PACK (ORAL), FAZACLO (ORAL), FLUPHENAZINE DECANOATE (INJECTION), FLUPHENAZINE ELIXIR/SOLN (ORAL), FLUPHENAZINE TABLET (ORAL), GEODON (INTRAMUSC), GEODON (ORAL), HALDOL (INJECTION), HALDOL DECANOATE (INTRAMUSC), HALOPERIDOL (ORAL), HALOPERIDOL DECANOATE (INJECTION), HALOPERIDOL LACTATE (INJECTION), HALOPERIDOL LACTATE CONC (ORAL), INVEGA (ORAL), INVEGA SUSTENNA (INTRAMUSC), LATUDA (ORAL), LOXAPINE (ORAL), OLANZAPINE (INTRAMUSC), OLANZAPINE ODT (ORAL), OLANZAPINE TABLET (ORAL), OLANZAPINE/FLUOXETINE (ORAL), ORAP (ORAL), PERPHENAZINE (ORAL), QUETIAPINE TABLETS (ORAL), RISPERDAL CONSTA (INTRAMUSC.), RISPERDAL ODT (ORAL), RISPERDAL SOLUTION (ORAL), RISPERDAL TABLET (ORAL), RISPERIDONE ODT (ORAL), RISPERIDONE SOLUTION (ORAL), RISPERIDONE TABLET (ORAL), SAPHRIS (SUBLINGUAL), SEROQUEL (ORAL), SEROQUEL XR (ORAL), SYMBYAX (ORAL), THIORIDAZINE (ORAL), THIOTHIXENE (ORAL), TRIFLUOPERAZINE (ORAL), VERSACLOZ (ORAL), ZIPRASIDONE CAPSULE (ORAL), ZYPREXA (INTRAMUSC), ZYPREXA (ORAL), ZYPREXA RELPREVV (INTRAMUSC), ZYPREXA ZYDIS (ORAL) Antidepressants, Other Paul Desan from CT Psychiatric Society and Dr. Dale Wallington spoke in favor of having all agents on formulary. Dr. Bassam Awwa provided testimony for Viibryd and Fetzima, and was in agreement with the previous speakers that all agents should be preferred. Chris Carello from Takeda and Aniello Marotta from Pfizer provided testimony for Brintellix and Pristiq, respectively. Manage Nissanka motioned to accept the recommendations as presented along with the addition of Brintellix, Viibryd, Fetzima, and Pristiq. His motion was seconded by Hilda Slivka, opposed by Kevin Chamberlin, and approved by the remaining members. The motion passed 8-1. ON Medicaid PDL: BRINTELLIX (ORAL), BUPROPION (ORAL), BUPROPION SR (ORAL), BUPROPION XL (ORAL), FETZIMA (ORAL), MARPLAN (ORAL), MIRTAZAPINE ODT (ORAL), MIRTAZAPINE TABLET (ORAL), PARNATE (ORAL), PHENELZINE (ORAL), PRISTIQ (ORAL), TRAZODONE (ORAL), VENLAFAXINE ER CAPSULES (ORAL), VIIBRYD (ORAL), VIIBRYD DOSE PACK (ORAL)
Antidepressants, SSRI The recommendations were presented to the committee, and there were no changes from the previous year. Kevin C motioned to accept as presented, and the motion was passed unanimously. ON Medicaid PDL: CITALOPRAM SOLUTION (ORAL), CITALOPRAM TABLET (ORAL), ESCITALOPRAM TABLET (ORAL), FLUOXETINE CAPSULE (ORAL), FLUOXETINE SOLUTION (ORAL), FLUOXETINE TABLET (ORAL), FLUVOXAMINE (ORAL), LEXAPRO SOLUTION (ORAL), PAROXETINE TABLET (ORAL), SERTRALINE CONC (ORAL), SERTRALINE TABLET (ORAL) Anticonvulsants The recommendations were presented for this class and there were no changes from the previous year. John McCarty from Sunovion provided testimony in support of Aptiom. Kevin C motioned to accept the recommendations as presented and the motion passed unanimously. ON Medicaid PDL: CARBAMAZEPINE CHEWABLE TABLET (ORAL), CARBAMAZEPINE ER (GENERIC CARBATROL) (ORAL), CARBAMAZEPINE SUSPENSION (ORAL), CARBAMAZEPINE TABLET (ORAL), CARBAMAZEPINE XR (ORAL), CARBATROL (ORAL), CELONTIN (ORAL), CLONAZEPAM (ORAL), DIASTAT (RECTAL), DIASTAT ACUDIAL (RECTAL), DILANTIN INFATAB (ORAL), DIVALPROEX ER (ORAL), DIVALPROEX SPRINKLE (ORAL), DIVALPROEX TABLET (ORAL), ETHOSUXIMIDE SYRUP (ORAL), FELBAMATE SUSPENSION (ORAL), GABITRIL (ORAL), LAMOTRIGINE TABLET (ORAL), LAMOTRIGINE TABLET DOSE PACK (ORAL), LEVETIRACETAM SOLUTION (ORAL), LEVETIRACETAM TABLETS (ORAL), OXCARBAZEPINE SUSPENSION (ORAL), OXCARBAZEPINE TABLETS (ORAL), PEGANONE (ORAL), PHENOBARBITAL ELIXIR (ORAL), PHENOBARBITAL TABLET (ORAL), PHENYTOIN CAPSULE (ORAL), PHENYTOIN EXT CAPSULE (GENERIC PHENYTEK) (ORAL), PHENYTOIN SUSPENSION (ORAL), PRIMIDONE (ORAL), TOPIRAMATE SPRINKLE (ORAL), TOPIRAMATE TABLETS (ORAL), VALPROATE SYRUP (ORAL), VALPROIC ACID (ORAL), VIMPAT SOLUTION (ORAL), VIMPAT TABLET (ORAL), ZONISAMIDE (ORAL) Botulinum Toxins The recommendations were presented, and Stella Cretella motioned to accept as recommended. Her motion was seconded by Kevin C and it passed unanimously. ON Medicaid PDL: BOTOX (INTRAMUSC) Bronchodilators, Beta Agonist Adam Denman from GSK provided testimony for Ventolin HFA. Carl S noted that the recommendations included other albuterol products that were more cost effective. Kathy Novak
noted the addition of a new product to this class, Striverdi Respimat, being recommended as preferred. Hilda S motioned to accept as presented and her motion was passed unanimously by the committee. ON Medicaid PDL: ALBUTEROL NEB SOLN 0.63, 1.25 MG (INHALATION), ALBUTEROL NEB SOLN 100 MG/20 ML (INHALATION), ALBUTEROL NEB SOLN 2.5 MG/3 ML (INHALATION), ALBUTEROL SYRUP (ORAL), ALBUTEROL TABLET (ORAL), PROAIR HFA (INHALATION), PROVENTIL HFA (INHALATION), STRIVERDI RESPIMAT (INHALATION), TERBUTALINE (ORAL) COPD Agents Adam Denman from GSK provided testimony for inclusion of Anoro Ellipta, and Dr. Patrick Troy provided testimony for Daliresp and Tudorza Pressair. Carl S noted Daliresp having positive impact on decreasing COPD exacerbations. Hilda S motioned to accept the recommendations with the addition of Anoro Ellipta and Daliresp. This was seconded by Manage N and approved unanimously. ON Medicaid PDL: ANORO ELLIPTA (INHALATION), ATROVENT HFA (INHALATION), COMBIVENT RESPIMAT (INHALATION), DALIRESP (ORAL), DUONEB (INHALATION), IPRATROPIUM / ALBUTEROL (INHALATION), IPRATROPIUM NEBULIZER (INHALATION), SPIRIVA (INHALATION) Cytokine and CAM Antagonists The recommendations were presented and Aniello Marotta from Pfizer provided testimony for the inclusion of Xeljanz. Arlene Price from Janssen provided testimony for Simponi and Stelara. Kathy N informed the committee that there were two new agents in this category, Ilaris and Arcalyst; both recommended as non-preferred. Kevin C motioned to approve the recommendations as presented, with Emmett Sullivan seconding. The motion passed unanimously. ON Medicaid PDL: ENBREL KIT (INJECTION), ENBREL PEN (INJECTION), ENBREL SYRINGE (INJECTION), HUMIRA KIT (INJECTION), HUMIRA PEN KIT (INJECTION) Epinephrine, Self-Injected Margaret Marsh from Mylan provided testimony for the inclusion of Epipen and Epipen Jr. Kathy N discussed how savings in this class will be dependent upon the ability to move market share away from the Epipen and Epipen Jr. Carl S doubted that the market shift could be met. The committee discussed the characteristics of the different injectors in this class. Kevin C motioned to reject the recommendations and to have Epipen and Epipen Jr as the only preferred agents in this class. His motion was seconded by Manage N and passed unanimously. ON Medicaid PDL: EPIPEN (INTRAMUSC), EPIPEN JR (INTRAMUSC)
Glucocorticoids, Inhaled The recommendations were presented, and Adam Denman from GSK provided testimony in support of Breo Ellipta. Carl S discussed the need for a range of different strengths of inhaled steroids that QVAR along does not satisfy. He also commented on Pulmicort and use in pregnancy. Hilda S motioned to accept the recommendations as presented with the addition of Asmanex, Flovent Diskus, Flovent HFA, and Pulmicort Flexhaler. Her motion was seconded and passed unanimously. ON Medicaid PDL: ADVAIR DISKUS (INHALATION), ASMANEX (INHALATION), DULERA (INHALATION), FLOVENT DISKUS (INHALATION), FLOVENT HFA (INHALATION), PULMICORT FLEXHALER (INHALATION), PULMICORT 0.25, 0.5 MG RESPULES (INHALATION), QVAR (INHALATION), SYMBICORT (INHALATION) Intranasal Rhinitis Agents The recommendations were presented for this class, and Alissa Amara from Teva provided testimony in support of QNASL. Stella Cretella motioned to accept the recommendations as presented and her motion was passed unanimously. ON Medicaid PDL: ASTEPRO (NASAL), FLUNISOLIDE (NASAL), FLUTICASONE (NASAL), IPRATROPIUM (NASAL), NASONEX (NASAL), PATANASE (NASAL) Neuropathic Pain The recommendations were presented, and Kathy noted the only change was preferring generic duloxetine and non-preferring its brand, Cymbalta. Hilda S motioned to accept the recommendations as presented and the motion passed unanimously. ON Medicaid PDL: DULOXETINE (ORAL), GABAPENTIN CAPSULE (ORAL), LIDODERM (TOPICAL), LYRICA CAPSULE (ORAL) NSAIDs The recommendations were presented and there were no changes from the previous year. Kevin C motioned to accept the recommendations as presented, and it passed unanimously. ON Medicaid PDL: ETODOLAC TAB SR (ORAL), FLECTOR (TOPICAL), FLURBIPROFEN (ORAL), IBUPROFEN SUSPENSION (ORAL), IBUPROFEN TABLET (ORAL), INDOCIN SUSPENSION (ORAL), INDOMETHACIN CAPSULE (ORAL), KETOPROFEN (ORAL), KETOROLAC (ORAL), MELOXICAM SUSPENSION (ORAL), MELOXICAM TABLET (ORAL), MOBIC SUSPENSION (ORAL), NABUMETONE (ORAL), NAPROXEN SODIUM (ORAL), NAPROXEN SUSPENSION (ORAL), NAPROXEN TABLET (ORAL), PIROXICAM (ORAL), SULINDAC (ORAL), VOLTAREN (TOPICAL) Oncology Agents, Oral
Prior to displaying the recommendations, Carl S conducted a straw poll of the committee to see if any members were interested in reversing their decision from the previous year to have all agents preferred, with the State having the ability to prefer a brand over its generic equivalent if the costs were lower. Emmett S asked for clarification as to how an available generic that was lower cost than the brand would be handled and Carl S answered that the brand and generic would be preferred in that case. Dawn Holcombe from CT Oncology Association provided the opinion of her committee is that all agents should be available, including all brand and generic products. Andrew L motioned to have all agents preferred, giving the State the ability to prefer a lower cost brand and non-prefer its generic in those situations. The motion was seconded and passed by all members of the committee with the exception of Emmett S, who opposed. Motion was passed 8-1. ON Medicaid PDL: AFINITOR (ORAL), AFINITOR DISPERZ (ORAL), ALKERAN (ORAL), BICALUTAMIDE (ORAL), BOSULIF (ORAL), CAPRELSA (ORAL), CASODEX (ORAL), COMETRIQ (ORAL), ERIVEDGE (ORAL), FLUTAMIDE (ORAL), GILOTRIF (ORAL), GLEEVEC (ORAL), HYDROXYUREA (ORAL), ICLUSIG (ORAL), IMBRUVICA (ORAL), INLYTA (ORAL), JAKAFI (ORAL), MEKINIST (ORAL), MERCAPTOPURINE (ORAL), NEXAVAR (ORAL), NILANDRON (ORAL), PURIXAN (ORAL), SPRYCEL (ORAL), STIVARGA (ORAL), SUTENT (ORAL), TAFINLAR (ORAL), TASIGNA (ORAL), TARCEVA (ORAL), TEMODAR (ORAL), TEMOZOLOMIDE (ORAL), TEMOZOLOMIDE (AG) (ORAL), TYKERB (ORAL), VOTRIENT (ORAL), XALKORI (ORAL), XELODA (ORAL)XTANDI (ORAL), ZELBORAF (ORAL), ZOLINZA (ORAL), ZYDELIG (ORAL), ZYKADIA (ORAL), ZYTIGA (ORAL) Oncology Agents, Breast Cancer The recommendations were presented for this class. Stella Cretella motioned to accept the recommendations as presented; it was seconded by Manage N, and passed unanimously. ON Medicaid PDL: ARIMIDEX (ORAL), EXEMESTANE (ORAL), LETROZOLE (ORAL), TAMOXIFEN CITRATE (ORAL) Smoking Cessation ON Medicaid PDL: BUPROPION SR (ORAL), CHANTIX (ORAL), CHANTIX DOSE PACK (ORAL), NICOTINE GUM OTC (BUCCAL), NICOTINE LOZENGE OTC (BUCCAL), NICOTINE LOZENGE OTC (MUCOUS MEM.), NICOTINE PATCH OTC (TRANSDERMAL) Stimulants and Related Agents
The recommendations were presented and it was noted that brand Provigil was recommended to become preferred, with its generic going to non-preferred. Andrew L asked how providers would prescribe for the brand. Jason Y informed the committee that no DAW is required on prescription when brand is preferred agent, and that HP implemented specific return messages on claims submissions for non-preferred generics. Andrew L motioned to accept the recommendations as presented, along with the addition of Ritalin LA. Hilda S seconded, and it was passed unanimously. ON Medicaid PDL: ADDERALL XR (ORAL), AMPHETAMINE SALT COMBO (ORAL), DAYTRANA (TRANSDERMAL), DEXMETHYLPHENIDATE (ORAL), DEXTROAMPHETAMINE TABLET (ORAL), FOCALIN (ORAL), FOCALIN XR (ORAL), INTUNIV (ORAL), METADATE CD (ORAL), METHYLIN CHEWABLE TABLETS (ORAL), METHYLPHENIDATE (ORAL), METHYLPHENIDATE ER (CONCERTA) (AG) (ORAL), METHYLPHENIDATE ER (CONCERTA) (ORAL), METHYLPHENIDATE ER (ORAL), METHYLPHENIDATE SOLUTION (ORAL), PROCENTRA (ORAL), PROVIGIL (ORAL), QUILLIVANT XR (ORAL), RITALIN LA (ORAL), RITALIN LA 10MG (ORAL), STRATTERA (ORAL), VYVANSE (ORAL) This ended the Public Presentation portion of the class review. The following classes did not have any public presentations. Andrew L had to leave the meeting at this time, so the following were voted on by the remaining 8 committee members. Alzheimer s Agents The recommendations were presented and Kevin C asked about status of immediate release Namenda. Kathy N answered that product is expected into 2015. Stella C motioned to accept the recommendations as presented and the motion was passed unanimously. ON Medicaid PDL: DONEPEZIL ODT (ORAL), DONEPEZIL TABLET (ORAL), EXELON (TRANSDERM.), GALANTAMINE ER (ORAL), NAMENDA SOLUTION (ORAL), NAMENDA TABLET (ORAL), NAMENDA TABLET DOSE PACK (ORAL), RIVASTIGMINE CAPSULES (ORAL) Anti-Allergens, Oral Kathy introduced this as a new class to the PDL review, and stated that it only contained two products; both of which were recommended as non-preferred. A motion was made to accept the recommendations as presented and it passed unanimously ON Medicaid PDL: NONE Antihistamines, Minimally Sedating The recommendations for the class were presented, and Kathy N noted that the major change was moving the fexofenadine family to non-preferred. The committee unanimously approved to accept the recommendations as presented.
ON Medicaid PDL: CETIRIZINE SOLUTION (ORAL), CETIRIZINE SOLUTION OTC (ORAL), CETIRIZINE-D OTC (ORAL), LORATADINE ODT OTC (ORAL), LORATADINE SOLUTION OTC (ORAL), LORATADINE TABLETS OTC (ORAL), LORATADINE-D OTC (ORAL) Antihypertensives, Sympatholytic The recommendations were presented and there were no changes from the previous year. Kevin C motioned to accept the recommendations as presented, and it was passed unanimously. ON Medicaid PDL: CATAPRES-TTS (TRANSDERM), CLONIDINE (ORAL), GUANFACINE (ORAL), METHYLDOPA (ORAL), METHYLDOPA/HYDROCHLOROTHIAZIDE (ORAL) Antihyperuricemics ON Medicaid PDL: ALLOPURINOL (ORAL), PROBENECID (ORAL), PROBENECID / COLCHICINE (ORAL) Antiparkinson s Agents ON Medicaid PDL: BENZTROPINE (ORAL), BROMOCRIPTINE (ORAL), CARBIDOPA / LEVODOPA (ORAL), CARBIDOPA / LEVODOPA ER (ORAL), CARBIDOPA / LEVODOPA ODT (ORAL), CARBIDOPA/LEVODOPA/ENTACAPONE (ORAL), PRAMIPEXOLE (ORAL), ROPINIROLE (ORAL), SELEGILINE CAPSULE (ORAL), SELEGILINE TABLET (ORAL), TRIHEXYPHENIDYL ELIXIR (ORAL), TRIHEXYPHENIDYL TABLET (ORAL) Antipsoriatics, Oral The recommendations were presented and there were no changes from the previous year. The committee unanimously passed a motion to accept the recommendations as presented. ON Medicaid PDL: OXSORALEN-ULTRA (ORAL), SORIATANE (ORAL) Antipsoriatics, Topical The recommendations were presented and a motion was made to accept the recommendations as presented; it was passed unanimously.
ON Medicaid PDL: CALCIPOTRIENE CREAM (TOPICAL), CALCIPOTRIENE OINTMENT (TOPICAL), CALCIPOTRIENE SOLUTION (TOPICAL), CALCITRIOL OINTMENT (TOPICAL) Anxiolytics ON Medicaid PDL: ALPRAZOLAM TABLET (ORAL), BUSPIRONE (ORAL), CHLORDIAZEPOXIDE (ORAL), CLORAZEPATE (ORAL), DIAZEPAM SOLUTION (ORAL), DIAZEPAM TABLET (ORAL), LORAZEPAM INTENSOL (ORAL), LORAZEPAM TABLET (ORAL) Bile Salts The recommendations were presented and Kathy N noted that the only change was flipping ursodiol tablets and capsules preferred statuses. Emmett S noted that they are not interchangeable at the pharmacy and would require a change to the prescription. Hilda S made a motion to accept the recommendations as presented, and it was passed unanimously. ON Medicaid PDL: URSODIOL TABLET (ORAL) Emollients ON Medicaid PDL: AMMONIUM LACTATE CREAM/LOTION (TOPICAL), LACTIC ACID CREAM/LOTION (TOPICAL) Glucocorticoids, Oral The recommendations for this class were presented and Kathy N announced this was a new class for the PDL. Kevin C motioned to accept the recommendations as presented and the motion passed unanimously. ON Medicaid PDL: DEXAMETHASONE SOLUTION (ORAL), DEXAMETHASONE TABLET (ORAL), ENTOCORT EC (ORAL), HYDROCORTISONE (ORAL), METHYLPREDNISOLONE TAB DS PK (ORAL), METHYLPREDNISOLONE TABLET (ORAL), ORAPRED (ORAL), ORAPRED ODT (ORAL), PREDNISOLONE SODIUM PHOSPHATE (ORAL), PREDNISOLONE SOLUTION (ORAL), PREDNISONE SOLUTION (ORAL), PREDNISONE TABLET (ORAL), VERIPRED 20 (ORAL) Histamine II Receptor Blockers
motion was made to accept the recommendations as presented and the motion passed unanimously. ON Medicaid PDL: CIMETIDINE TABLET (ORAL), CIMETIDINE TABLET OTC (ORAL), FAMOTIDINE TABLET (ORAL), FAMOTIDINE TABLET OTC (ORAL), PEPCID SUSPENSION (ORAL), RANITIDINE SYRUP (ORAL), RANITIDINE TABLET (ORAL), RANITIDINE TABLET OTC (ORAL) Immunomodulators, Atopic Dermatitis The recommendations were presented and there were no changes from the previous year. Hilda S motioned to accept the recommendations as presented and the motion was passed unanimously. ON Medicaid PDL: ELIDEL (TOPICAL) Immunomodulators, Topical motion was made to accept the recommendations as presented and the motion passed unanimously. ON Medicaid PDL: ALDARA (TOPICAL) Iron, Oral The recommendations were presented and Hilda S questioned why the children s elixir was not included in the review. Kathy N said she would follow up on the question after the meeting. A motion was made to accept the recommendations as presented and passed unanimously. ON Medicaid PDL: FEOSOL TABLET OTC (ORAL), FERATE TABLET OTC (ORAL), FERRALET 90 DUAL-IRON TABLET (ORAL), FERRAPLUS 90 TABLET (ORAL), FERRIMIN 150 TABLET OTC (ORAL), FERROCITE PLUS TABLET (ORAL), FERROUS FUMARATE/ASCORBIC ACID/B12-IF/FA CAPSULE (ORAL), FERROUS FUMARATE/FA/MULTIVITAMIN & MINERALS CAPSULE (ORAL), FERROUS FUMARATE/IRON POLYSACCHARIDES/FA/MULTIVITAMIN CAPSULE (ORAL), FERROUS GLUCONATE TABLET OTC (ORAL), FERROUS SULFATE SOLUTION OTC (ORAL), FERROUS SULFATE TABLET ER OTC (ORAL), FERROUS SULFATE TABLET OTC (ORAL), FERROUS SULFATE, DRIED TABLET ER OTC (ORAL), FERROUS SULFATE/ASCORBIC ACID/FA TABLET ER OTC (ORAL), FOLIVANE-F CAPSULE (ORAL), FOLIVANE-PLUS CAPSULE (ORAL), HEMATOGEN CAPSULE (ORAL), HEMATOGEN FA CAPSULE (ORAL), HEMOCYTE PLUS CAPSULE (ORAL), HEMOCYTE-F TABLET (ORAL), INTEGRA CAPSULE OTC (ORAL), INTEGRA F CAPSULE (ORAL), INTEGRA PLUS CAPSULE (ORAL), IRON CARBONYL/ASCORBIC
ACID TABLET OTC (ORAL), IRON POLYSACCHARIDES CAPSULE OTC (ORAL), IRON POLYSACCHARIDES/B12/FA CAPSULE (ORAL), NEPHRON FA TABLET (ORAL), NOVAFERRUM 50 CAPSULE OTC (ORAL), NOVAFERRUM DROPS OTC (ORAL), NU- IRON 150 CAPSULE OTC (ORAL), TANDEM DUAL ACTION CAPSULE OTC (ORAL), TANDEM PLUS CAPSULE (ORAL), TARON FORTE CAPSULE (ORAL), TL-FOL 500 TABLET ER (ORAL), TL-HEM 150 TABLET ER 24H (ORAL), VITRON-C TABLET DR OTC (ORAL) Leukotriene Modifiers ON Medicaid PDL: ACCOLATE (ORAL), MONTELUKAST CHEWABLE TABLET (ORAL), MONTELUKAST TABLET (ORAL) Ophthalmic Antibiotics The recommendations were presented. A motion was made to accept the recommendations as presented, and it was passed unanimously ON Medicaid PDL: BACITRACIN/POLYMYXIN B SULFATE OINT. (OPHTHALMIC), ERYTHROMYCIN (OPHTHALMIC), GENTAMICIN DROPS (OPHTHALMIC), GENTAMICIN OINT. (OPHTHALMIC), MOXEZA (OPHTHALMIC), NEOMYCIN- POLYMYXIN-GRAMICIDIN (OPHTHALMIC), OFLOXACIN (OPHTHALMIC), POLYMYXIN/TRIMETHOPRIM (OPHTHALMIC), SULFACETAMIDE SOLUTION (OPHTHALMIC), TOBRAMYCIN (OPHTHALMIC), TOBREX OINTMENT (OPHTHALMIC), VIGAMOX (OPHTHALMIC) Ophthalmic Antibiotic-Steroid Combinations ON Medicaid PDL: BLEPHAMIDE (OPHTHALMIC), BLEPHAMIDE S.O.P. (OPHTHALMIC), NEOMYCIN/BACITRACIN/POLY/HC (OPHTHALMIC), NEOMYCIN/POLYMYXIN/DEXAMETHASONE (OPHTHALMIC), PRED-G DROPS SUSP (OPHTHALMIC), PRED-G OINT. (OPHTHALMIC), SULFACETAMIDE / PREDNISOLONE (OPHTHALMIC), TOBRADEX OINTMENT (OPHTHALMIC), TOBRADEX SUSPENSION (OPHTHALMIC) Ophthalmics for Allergic Conjunctivitis
ON Medicaid PDL: ALREX (OPHTHALMIC), CROMOLYN SODIUM (OPHTHALMIC), PATADAY (OPHTHALMIC) Ophthalmic Anti-Inflammatories The recommendations were presented and Kathy N noted the change in recommendation for prednisolone acetate was based on a trend of rising costs for that drug. A motion was made to accept the recommendations as presented, and it was passed unanimously. ON Medicaid PDL: DEXAMETHASONE (OPHTHALMIC), DICLOFENAC (OPHTHALMIC), DUREZOL (OPHTHALMIC), FLAREX (OPHTHALMIC), FLUOROMETHOLONE (OPHTHALMIC), FLURBIPROFEN (OPHTHALMIC), FML FORTE (OPHTHALMIC), FML S.O.P. (OPHTHALMIC), ILEVRO (OPHTHALMIC), KETOROLAC (OPHTHALMIC), KETOROLAC LS (OPHTHALMIC), LOTEMAX DROPS (OPHTHALMIC), MAXIDEX (OPHTHALMIC), PRED MILD (OPHTHALMIC), PREDNISOLONE SOD PHOSPHATE (OPHTHALMIC) Ophthalmics, Glaucoma Agents The recommendations were presented and there were no changes from the previous year. The committee motioned to accept as presented, and it passed unanimously. ON Medicaid PDL: ALPHAGAN P 0.15% (OPHTHALMIC), AZOPT (OPHTHALMIC), BETAXOLOL (OPHTHALMIC), BETIMOL (OPHTHALMIC), BETOPTIC S (OPHTHALMIC), BRIMONIDINE (OPHTHALMIC), CARTEOLOL (OPHTHALMIC), DORZOLAMIDE (OPHTHALMIC), DORZOLAMIDE / TIMOLOL (OPHTHALMIC), ISTALOL (OPHTHALMIC), LATANOPROST 2.5 ML (OPHTHALMIC), LEVOBUNOLOL (OPHTHALMIC), METIPRANOLOL (OPHTHALMIC), PILOCARPINE (OPHTHALMIC), SIMBRINZA (OPHTHALMIC), TIMOLOL (OPHTHALMIC), TRAVATAN Z 2.5 ML (OPHTHALMIC), TRAVATAN Z 5 ML (OPHTHALMIC) Otic Antibiotics motion was made to accept the recommendations as presented. The motion was passed unanimously. ON Medicaid PDL: CIPRODEX (OTIC), CORTISPORIN SOLUTION (OTIC), NEOMYCIN/POLYMYXIN/HC SOLN/SUSP (OTIC), OFLOXACIN (OTIC) Otic Anti-Infectives and Anesthetics The recommendations were presented and a motion was made to accept the recommendations as presented; it was passed unanimously. ON Medicaid PDL: ACETIC ACID (OTIC), ANTIPYRINE / BENZOCAINE (OTIC)
Sedative Hypnotics ON Medicaid PDL: FLURAZEPAM (ORAL), TEMAZEPAM (ORAL), ZOLPIDEM (ORAL) Steroids, Topical Low Potency ON Medicaid PDL: CAPEX SHAMPOO (TOPICAL), DESONIDE CREAM (TOPICAL), DESONIDE LOTION (TOPICAL), DESONIDE OINTMENT (TOPICAL), DESOWEN LOTION (TOPICAL), FLUOCINOLONE 0.01% OIL (TOPICAL), HYDROCORTISONE / MIN OIL / PET OINTMENT (TOPICAL), HYDROCORTISONE CREAM (TOPICAL), HYDROCORTISONE GEL (TOPICAL), HYDROCORTISONE OINTMENT (TOPICAL) Steroids, Topical Medium Potency The recommendations were presented and the committee motioned to accept the class as presented. The motion passed unanimously. ON Medicaid PDL: HYDROCORTISONE BUTYRATE CREAM (TOPICAL), HYDROCORTISONE BUTYRATE CREAM BRAND (TOPICAL), HYDROCORTISONE BUTYRATE OINTMENT BRAND (TOPICAL), HYDROCORTISONE BUTYRATE SOLUTION (TOPICAL), HYDROCORTISONE BUTYRATE SOLUTION BRAND (TOPICAL), HYDROCORTISONE VALERATE CREAM (TOPICAL), HYDROCORTISONE VALERATE OINTMENT (TOPICAL), MOMETASONE FUROATE CREAM (TOPICAL), MOMETASONE FUROATE OINTMENT (TOPICAL), MOMETASONE FUROATE SOLUTION (TOPICAL) Steroids, Topical High Potency The recommendations were presented for this class. The committee motioned to accept the recommendations as presented, and it was passed unanimously. ON Medicaid PDL: BETAMETHASONE DIPROPIONATE CREAM (TOPICAL), BETAMETHASONE DIPROPIONATE LOTION (TOPICAL), BETAMETHASONE VALERATE CREAM (TOPICAL), BETAMETHASONE VALERATE LOTION (TOPICAL), BETAMETHASONE VALERATE OINTMENT (TOPICAL), FLUOCINONIDE CREAM (TOPICAL), FLUOCINONIDE EMOLLIENT (TOPICAL), FLUOCINONIDE GEL (TOPICAL), FLUOCINONIDE SOLUTION (TOPICAL), TRIAMCINOLONE ACETONIDE CREAM (TOPICAL), TRIAMCINOLONE ACETONIDE OINTMENT (TOPICAL)
Steroids, Topical Very High Potency ON Medicaid PDL: CLOBETASOL EMOLLIENT (TOPICAL), CLOBETASOL PROPIONATE CREAM (TOPICAL), CLOBETASOL PROPIONATE GEL (TOPICAL), CLOBETASOL PROPIONATE OINTMENT (TOPICAL), CLOBETASOL PROPIONATE SOLUTION (TOPICAL), CLOBEX SHAMPOO (TOPICAL), HALOBETASOL PROPIONATE CREAM (TOPICAL), HALOBETASOL PROPIONATE OINTMENT (TOPICAL) Recommendations for next class reviews: Magellan recommended the following classes be reviewed at the next P&T meeting: Next Classes to Review: 1. ACNE AGENTS, TOPICAL 2. ANALGESICS, NARCOTICS LONG 3. ANALGESICS, NARCOTICS SHORT 4. ANDROGENIC AGENTS 5. ANGIOTENSIN MODULATOR COMBINATIONS 6. ANGIOTENSIN MODULATORS 7. ANTIBIOTICS, GI 8. ANTIBIOTICS, INHALED 9. ANTIBIOTICS, TOPICAL 10. ANTIBIOTICS, VAGINAL 11. ANTICOAGULANTS 12. ANTIEMETIC/ANTIVERTIGO AGENTS 13. ANTIFUNGALS, ORAL 14. ANTIFUNGALS, TOPICAL 15. ANTIMIGRAINE AGENTS, OTHER 16. ANTIMIGRAINE AGENTS, TRIPTANS 17. ANTIPARASITICS, TOPICAL 18. ANTIVIRALS, ORAL 19. ANTIVIRALS, TOPICAL 20. BETA-BLOCKERS 21. BLADDER RELAXANT PREPARATIONS 22. BONE RESORPTION SUPPRESSION AND RELATED AGENTS 23. BPH TREATMENTS 24. CALCIUM CHANNEL BLOCKERS 25. CEPHALOSPORINS AND RELATED ANTIBIOTICS 26. COLONY STIMULATING FACTORS 27. CONTRACEPTIVES, ORAL
28. DIURETICS 29. ERYTHROPOIESIS STIMULATING PROTEINS 30. FLUOROQUINOLONES, ORAL 31. GROWTH FACTORS 32. GROWTH HORMONE 33. HAE TREATMENTS 34. H. PYLORI TREATMENT 35. HEPATITIS B AGENTS 36. HEPATITIS C AGENTS 37. HYPOGLYCEMICS, ALPHA-GLUCOSIDASE INHIBITORS 38. HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS 39. HYPOGLYCEMICS, INSULIN AND RELATED AGENTS 40. HYPOGLYCEMICS, MEGLITINIDES 41. HYPOGLYCEMICS, METFORMINS 42. HYPOGLYCEMICS, SGLT2 43. HYPOGLYCEMICS, TZD 44. IMMUNOSUPPRESSIVES, ORAL 45. IRRITABLE BOWEL SYNDROME 46. LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMINS 47. LIPOTROPICS, OTHER 48. LIPOTROPICS, STATINS 49. MACROLIDES/KETOLIDES 50. MULTIPLE SCLEROSIS AGENTS 51. OPIATE DEPENDENCE TREATMENTS 52. PAH AGENTS, ORAL AND INHALED 53. PANCREATIC ENZYMES 54. PENICILLINS 55. PHOSPHATE BINDERS 56. PITUITARY SUPPRESSIVE AGENTS, LHRH 57. PLATELET AGGREGATION INHIBITORS 58. PRENATAL VITAMINS 59. PROTON PUMP INHIBITORS 60. SKELETAL MUSCLE RELAXANTS 61. TETRACYCLINES 62. THYROID HORMONES 63. ULCERATIVE COLITIS AGENTS 64. VASODILATORS, CORONARY New Generics: Kathy N presented to the committee members the following new generic products which would be non-preferred on the Medicaid formulary: HYDROMORPHONE ER OXYCODONE ER TESTOSTERONE
TESTOSTERONE TESTOSTERONE AMLODIPINE/VALSARTAN VALSARTAN TOPIRAMATE ER DESVENLAFAXINE ER METHOXSALEN CALCIPOTRIENE/ BETAMETHASONE RISEDRONATE RALOXIFENE CIPROFLOXACIN AZELASTINE BUDESONIDE OLOPATADINE FENOFIBRATE OMEGA-3 ACID ETHYL ESTERS DICLOFENAC SEVELAMER CARBONATE ESZOPICLONE Schedule next meeting: Committee members suggested that a set of available dates be emailed to committee members for review. Available dates will be sent to the committee by Jason Y. Meeting adjourned at 8:16pm